Book for Review: Risjord's - Nursing Knowledge - Science, Practice, and Philosophy

In order to put Hodges' model on a more theoretical and practical footing (especially as part of an extended project) I approached the publishers of Mark Risjord's Nursing Knowledge: Science, Practice, and Philosophy. Wiley-Blackwell have kindly forwarded me a review copy of this book.

My preoccupation with nursing theory, practice and informatics could form the basis of a multiple choice question:

Having an earnest interest in nursing theory, practice and informatics is:

a) a grand academic and intellectual enterprise (you're a historian, journalist and futurologist).
b) a sign of our times for ALL nurses (doh!) this is the 21st century after all.
c) a contradiction in terms.
d) a sign you are informationally overloaded, trapped in the gap.

Seriously, the effort to understand nursing, informatics and retrofit theory (conceptual spaces, threshold concepts...?) to support Hodges' model needs to be philosophically sound - rigorous. This book will help.

Reflections [III] Conceptual Spaces At Work: Lund University, Sweden, May 2012

The next session - Event Structure, Conceptual Spaces and the Semantics of Verbs Peter Gärdenfors, Massimo Warglien & Matthijs Westera, was presented by Peter Gärdenfors whose book Conceptual Spaces (2000) I bought in Sedbergh in 2008 (talk about serendipity!).

Just reading the title back then was enough...

There was a starter question: Why are there word classes (nouns, verbs, adverbs...)?

It became evident that first morning that conceptual space as a representational form is very much still in active development. The abstract begins:

The aim of this paper is to integrate spatial cognition with lexical semantics. We develop cognitive models of actions and events based on conceptual spaces and vectors on them. The models are then used to present a semantic theory of verbs. ...

Word classes were related (as in the book) to conceptual space elements, e.g.

nouns - categories
adjectives - properties

In addressing verbs this paper seeks a two-vector model of an event.

Agent (Force) -> Patient (Result)   - result verbs describe the change in the object.

The Professor said that cognitive and linguistic aspects are often confused. Two theses were also provided - thesis 2: single domain constraint.

In addition talk of several spaces might be troubling (adding complexity), but to me the prospects of action space, category space and physical space makes the potential for modelling more explicit and accessible to Hodges' model.

I scribbled down 'agent not always necessary (fall, growth?...)' and pondered about self-care, relatives acting as a proxy.

There was a lot of detail on language, linguistics: static verbs, intentional verbs -> physical action; telic verbs. ... Rather than feel (completely!) confused by this specialist talk, I felt enthused for what is to follow.

Reflections [II] Conceptual Spaces At Work: Lund University, Sweden, May 2012

[See also Reflections I CSaW2012]

Among many things Dessalles - From Conceptual Spaces to Predicates - told us that meaning is essentially two-fold: analogue and symbolic.

An evocative summary was provided:

(Topo)logical thinking = Conceptual spaces + Contrast

Concepts do not exist as permanent structures.
Predicates are ephemeral.
Questions included: Is there a contrast logic?

You can find Dessalles online and there is a specific book Why We Talk (2007) (some of the chapters look particularly interesting - information).

Also to investigate are there being no locality principle and the danger of holism, and a point about structural matching as part of problems with traditional approaches to meaning that involve interfaces and relationship structures (pardon the ramble - the paper has not appeared yet).

Geuder's Manner Modification and the Representation of Event Concepts found me tweeting - see below. A biomotion demo was tied to the theme emphasizing perceptual cues, manner and meaning.

Off at a tangent the title had me musing on the importance of 'manner modification' in nursing. Sometimes fleetness of attitudinal, objective and emotional foot is needed to deal with a care situation. Tangent aside, there are clearly some serious considerations around health care processes, these are the bread and butter of healthcare records and information systems.

I've just copied my tweets (clinical examples arose in several sessions):

Gardenfors & Warglien ref new paper?* subspaces corres to a division into domains - event concepts

Manner modification eg. "slowly". (Manner central in health nursing) +mention of forgetting + absentmindedness denotes? PTSD?

A representation of a stage structure is needed - further e.g. "carefully" He cleaned the wound...  filled by context (as ever)

Geuder still, now on emotional state predicates - "sadly" Three possible ways to proceed - close now

* The following may be the new paper:

Peter Gärdenfors and Massimo Warglien Using Conceptual Spaces to Model Actions and Events. J of Semantics first published online April 17, 2012 doi:10.1093/jos/ffs007

Reflections [I] Conceptual Spaces At Work: Lund University, Sweden, May 2012

I started writing up and reflecting on my notes while still in Lund on Saturday evening 26th May. As I passed the taxi rank returning to my B&B I knew Eurovision had started: Englebert sang out. It was quite novel to be in Sweden that night.

The conference was excellent.

Lund is a beautiful, friendly city and the weather was amazing.

I am so pleased I made this journey and would like to thank the organisers and sponsors for their work and support. The conference was free to attend, which greatly assisted me. Speakers were in the majority which added to the event's value for me (and the other participants). Some of the presentations included maths and logic, but as I was advised initially I could follow the gist of all the presentations and the details of many.

If you are a nurse, social worker, occupational therapist... and you read through these follow-up posts you may well wonder how is this relevant to healthcare? Well at the moment that is unclear, but I'm sure there is a connection. I'll share some tentative connections here and add some photographs over the next few weeks or so. As I review my scribbled notes I may have made some mistakes, missed out key points and references are still appearing, but here goes ...

The first session on Thursday was by Carita Paradis, who presented White aromas and subtle oak spices: From sensory experiences to language through conceptual spaces. Carita's focus was wine tasting with its four sensory modalities of VISION, SMELL, COLOR, and TASTE and a descriptors list for the properties of wines, such as sharp, soft, lemon and cherry. There is a corpus as the paper explains:

... the source of data used in this investigation is the American wine magazine, the Wine Advocate. The corpus contains 84,864 wine reviews published 1989 – 2006. The total number of words used is 8,332,666 and the number of different words is 46,000 (for more information about the corpus as such and an interactive information visualization (InfoViz) tool to be used to retrieve different kinds of information about the wines reviewed, both linguistic information and metadata, ... p.4.

In addition for both red and white wines there is an aroma wheel. It was helpful in the Q&A at the end to be reminded of the relative dominance of the senses. Questions had me recalling the emotional and reflexive response of disgust and how this is 'hardwired' - the limbic system and connected to other senses. The findings of a lower to higher directionality in modalities - touch through to sound and vision and the use of metaphors and the direction of these: soft light OK but not light softness was fascinating.

So, there are more reasons for a blog post than the four senses referred to by Carita. What descriptors are there for the four care domains (interpersonal, sciences, political and social)? How can they be discovered (or recovered)? Where is the corpus for nursing? Is there a secondary source? Is there a case for a different approach? Are there several in the form of nursing classification and terminology systems?

As to the other sense: I also wondered about the sound of money and advertising (of alcohol), generally more tightly controlled in Sweden as I understand, especially advertising aimed at children.

Carita Paradis & Mats Eeg-Olofsson, Describing sensory experience recontextualization through properties, objects and imagery in discourse, Lund University 

PJ's project [iii]: Hodges' model An aide mémoire, or candidate Gärdenforsian conceptual space?

If you have a 'project' then chances are at some point you're going to commit it to paper as a text or Gantt chart...

Last November I posted an outline and some reflections about a project that I suppose has been a career in the making. This blog is part of the 'output': a channel that is open.

I am writing this in Lund, Sweden. The people, weather, the lilac and other scents on the breeze are a real joy. I'm here to attend the Conceptual Spaces at Work conference which starts tomorrow.

Part of the rationale for attending is to see if I've found a tree worthy of stressing my vocal cords over. If you compare the copy below with November then some changes should be apparent. For example, I wasn't aware of CSML back then. This conference is not so much about trying to fill in gaps, but finding them. Here is the latest listing:

Abstract
    Preface
    Introduction
    1.1 Health and Social Care
    1.2 Recurring Issues in Health and Social Care
    2 Education
     Introduction
    2.1 Education in the 21st Century
    2.2 Recurring Issues in Education
    3 Nursing, Nursing Theory and Hodges' model
    Introduction
    3.1 Sciences, Medicine and Nursing Disciplines
    3.2 Scope of Nursing Practice
    3.3 The case for models of care: Simplification, speech, writing
    3.4 Nursing Process
    3.5 Data Initialisation In Nursing
    3.6 Nursing Theory : All In The Mind?
    3.7 Hodges' Health Career - Care Domains - Model
    3.8 Problems With Models - Critique
    3.9 Problems with Hodges' health career – care domains – model
    4 Information
    Introduction
    4.1 Information, energy, records
    4.2 Clinical Classification and Coding
    5 Cognitive Science, Learning and Literacy, Computation
    Introduction
    5.1 Cognitive and Learning styles
    5.2 Models, Contexts, Situations, the Project and (Darwinian) Justification
    5.3 Forms of Literacy, Requirements and Socio-Technical Perspectives
    5.4 Computation and Computer Graphics
    5.5 Visual Software
    5.6 Software Development, data, models, applications
    5.7 Data Abstraction and Databases
    5.8 Object Oriented Programming
    5.9 Coding and Classification, Ontologies, RDF, Semantic Web
    6 Gardenfors' Conceptual Spaces
    Introduction
    6.1 Representation, Explanation and Construction
    6.2 Background on key research methods
    6.3 Gärdenfors conceptual spaces - selected definitions
    7 Hodges' model as a Conceptual Space
    Introduction
    7.1 Indicative Literature Review
    7.2 H2CM, Data, Data, Data, (Data!) and research methods
    7.3 Hodges’ model as a Conceptual Space
    7.4 Quality dimensions – discrete vs continuous and confluent
    8 Sandbox: Drupal, Ruby, CSML and SVG
    Introduction
    8.1 Scalable Vector Graphics (SVG): Web Graphics
    8.2 Conceptual Space Markup Language (CSML)
    8.3 Drupal: Open source content management system
    8.4 Ruby
    8.5 Domains and Domain Specific Languages
    9 Closing Discussion: Values
    Introduction
    Figures
    Tables
    Acknowledgements

I would love to attend SVG Open - The Graphical Web in September, but I have to cut the cloth as a dad, boyfriend, and full-time nurse... This year, ten days unpaid leave will help me pursue this work. It's not that I can necessarily afford to sacrifice salary like this, but at present it suits the NHS and me.

As to the text there will be lots more changes to follow no doubt. Chapter 4 has latent emergent properties - I hope. One struggle is 'chapters' 1 & 2, which provide a background to healthcare and education; and the closing discussion. In C1 for example, the issues include person-centered care, multidisciplinary care, records, information. ... In a way they are also themes, it's finding the right descriptor. Actually, as I write perhaps this issues-themes thing is related to there being issues that are problems that have a solution if only we can find it?

It's a big ask, but C8 and reference to the sandbox says it all. Whether it is a case of issues, themes, or problems in nursing, health and social care it is values that count. I'm hoping there's a circle there that can be closed. Then the project really becomes a baton: and I can help pass it on ...

More to follow over the next few days.

Many thanks also to Rikard for the welcome at Hobykrok B&B and the loan of a power adapter!

106? No. That is not the meaning of 'personalised' care [I]

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Person-alised care c/o Andrea, Jamal, Leila, Kareem, Nada, Cassie, Graham, Addy, Gizela, Sandra, Kate, Tony, Em, ...	Diagnosis - dementia, confusion, agitation Care needs include: personal hygiene, dressing, washing ...
Carer - support relationship building trust, empathy, rapport...	106 Policy, Governance, Audit, Outcomes, Feedback, Commissioning, ...

What is the meaning of continuity?

BBC News: Dementia patient 'had 106 carers'.

Visual means: Patient Status at a Glance (PSAG)

A recent HSJ came with a CHKS supported document on Top Hospitals. Page 14 considers Worldwide comparison and learning from others with three items on Patient Status at a Glance (PSAG) Boards; Developing a safety culture; and Reducing readmissions.

All are related (communication, safety, outcomes, multidisciplinary collaboration), but PSAG stands out to me for obvious reasons as it acknowledges the value of visual management, a quick heads-up overview of status. On PSAG four brief sentences note that South Tees Hospital NHS Foundation Trust in the UK has applied experience from Virginia Mason Medical Center in Seattle to develop PSAG in surgery.

Of course this application is focussed, being quite specific in the value of fewer nursing interruptions and a daily update for bed managers. This now contributes to making many wards more productive.

Hodges' model is a 'PSAG' of sorts, but it is more general, global in scope, summative. Perhaps it could act as a precursor to discharge?

Like the astronomer's blink comparator it could provide a before:after visual cue.

So, I wonder if Hodges' model could provide not only Patient Status upon Reflection, but Care Status upon Collective Reflection. This is vital at a time when we also need the patient and carers to be more productive in terms of supporting and sustaining their own care.

[HIFA2015] International Nurses Day, May 12 "Closing the gap: From evidence to action"

Dear Colleagues / collaborators,

Nurses worldwide under the umbrella of the International Council of Nurses celebrates the International Nurses Day yearly on May 12. This is to pay tribute to the millions of men and women who put their lives to the service of humanity, in accordance with convention 149 of the ILO (Nursing Personnel Convention) passed in 1997. This celebration however has not yet gained the recognition it should, for how can one explain the fact that this day may even go by unnoticed in some countries, or are we therefore saying it is not worth it and why is this day not even a public holiday like for other professional groups.

I find it hard to believe that until now on this forum no one could think of it, when the celebration is due in barely 36 hours. I understand the delicate nature of health jobs, but this should not be an excuse for not paying tribute where is it due. I know this day should be meant for reflection among nurses and seeking for ways to improve nursing services. This will not happen in isolation, for nurses need the political will and inter sectoral collaboration to do their job effectively, shape a better future for the next generation of nurses consonant with current stakes.

This year, nurses are deliberating on the theme 'closing the gap: From evidence to action'. This topic is quite elaborate and needs lots of considerations both within and without the influence of nurses. Understanding evidence-based practice, seeking for sources of evidence, making the appropriate case for change and moving from evidence to action is the cycle in which nurses hope to reflect as they celebrate this year. Nurses will need new skills and expertise to deal with their clients in today's changing and challenging health environment. This is why this forum is of vital importance and I will continue to thank the team behind it. Nursing training programs may be subject to revision, expanding the legal and professional limits of practice while maintaining strict regulatory sanctions. This increased autonomy will enable nurses take up new functions within the confines of their practice and help in meeting the health needs of our population and not acting as physician substitutes or mini-doctors.

Therefore, I wish all nurses a happy celebration, calling on them to use the very rich celebration kit from the ICN, easily downloadable from their website, www.icn.ch, and share among themselves in all settings where nurses live and work. It is our day and we should be happy and honoured for the services we offer to the six billion people on earth, since nurses form the bulk of health care providers and work in remote areas in all countries.

In Cameroon, thousands of nurses from all the ten regions, shall be meeting in the economic capital Douala between June 14 to 16, to brainstorm on the activities. This event is usually opened by the Minister of Public health or his representative, various scientific presentations, round table conferences and other important activities grace the event and concluded by a closing ceremony during which important decisions taken are communicated to participants.

Tita Pale Isa Ndognjem, BSc, RN
Public Relation officer, Cameroon Nurses Association
2012 Fellow, Commonwealth Nurses Federation
paleisa AT yahoo.com 

Additional link:

C149 Nursing Personnel Convention, 1977
Convention concerning Employment and Conditions of Work and Life of Nursing Personnel (Note: Date of coming into force: 11:07:1979.) 
 
My source: HIFA2015

International Nurses Day - Closing the gap: My Project for a Global Conceptual Framework for Nursing

As International Nurses Day is celebrated tomorrow on the 12th May the emphasis and work here at W2tQ lies with Hodges' model. The project is to publicise h2cm's international potential in providing an avenue to help unify nursing theory, practice and assure future research.

Fawcett wrote of the metaparadigm of nursing - namely the inclusion of the concepts of person; environment; health; and nursing.

These concepts are incorporated into Fawcett's criteria on model validation which are listed in bold-italic below.

I have also ventured some reflections on the current status of h2cm when compared against these criteria.

Assumptions underlying the conceptual model are made explicit.

It is not sufficient, but the structure of Hodges' model renders the assumptions within the model explicit. The structure identifies eight initial key concepts:

INDIVIDUAL, GROUP (population); HUMANISTIC, MECHANISTIC; SCIENCES, POLITICS, SOCIOLOGY, INTERPERSONAL

A complete description of all four concepts of nursing's metaparadigm are presented.

Reflection soon reveals that several environments are suggested:

PHYSICAL, ORGANISATION, COMMUNITY, HOME, RESIDENCES, DWELLINGS, COGNITIVE (conceptual), SYMBOLIC, ABSTRACT, VIRTUAL, FORUMS, COLLEGES

Propositions of the conceptual model completely link the four meta-paradigm concepts. 

This is feasible, reasoning from the foundation of the model's structure.

The internal structure of the conceptual model is logically congruent.

This does need to be demonstrated. Initial recognition of logical congruence might be found through the conjoining of disciplines, that is frequently taken for granted: PSYCHO-SOCIAL; SOCIO-TECHNICAL; SOCIO-ECONOMIC.

The conceptual model is socially congruent, socially significant, and socially useful.

I have claimed on numerous occasions that the model is agnostic, universal, accessible, and has educational potential. These and other qualities need to be critically examined.

Empirical evidence in support of the model has accumulated from many derived theories.

The two final criteria are the most challenging. Empirical evidence supporting Hodges' model is available, but again must be tested through research. If someone has time - could you please compare the frequency of a set of political concepts in the nursing literature since 1985?* The emergence of health literacy and self-efficacy, threshold concepts, conceptual spaces, the rise of the semantic web and developments in software can all potentially support h2cm. Producing a roll-call of some of the latest trends in contemporary education, research and culture is not good enough, specific studies are needed.

The total contribution of the conceptual model to nursing knowledge. 

There is a long, long way to go, but the contribution has begun ... every journey ...

Of course, it is almost 20 years since publication of Fawcett's criteria. Has the concept of congruence changed in that time? What is socially significant and useful now? What should the social and political weighting of evaluative criteria be in 2012...? There is a body of critique upon Fawcett's and other evaluative tools within nurse education.

Perhaps a new set of criteria could be defined using h2cm itself? For a model of nursing (health and social care) to be fit for purpose, acceptable and viable across the globe, there are new concepts to be represented. While that would certainly close a gap, it does not seem a rigorous or valid way to proceed. I will seek out other more recent criteria and present them here at some point.

Fawcett J. Analysis and Evaluation of Conceptual Models of Nursing, 3rd ed. Philadelphia, Pa: FA Davis; 1995.

*Many thanks - if someone should pick this up, which ever axes, concept or issue.

Visual Methodologies Doctoral Training Workshop 26 - 27 June 2012

Developing Theory & Practice in Visual Methodologies

The School of Education, Communication & Language Sciences and Durham University’s School of Education are holding a two-day workshop for doctoral students on the development and use of visual methodologies.

The workshop will take place on Tuesday, 26 June and Wednesday, 27 June 2012 at Newcastle University.

Further information about the workshop and how to register can be found at:

http://www.dur.ac.uk/education/postgraduate/visualmethodologies/

The workshop is part of the North East Doctoral Training Centre’s (NEDTC) annual programme of advanced training in the social sciences.

Please do not hesitate to contact Anne Parks ( NEDTC Secretary email a.l.park AT durham.ac.uk ) if you need any further information about the event.

My source:
ESA-ALL at JISCMAIL.AC.UK

Conceptual Space Markup Language (CSML): Towards the Cognitive Semantic Web

I'll start May hopefully in tune with plans towards the month's end and attending Conceptual Spaces at Work.

The SCIENCES domain page has included Markup Languages (ML) for a great many years.

In the early versions of the h2cm website there were just two 'resource' pages. When the ongoing four page format arrived then markup languages had a place.

Looking at the programme for next month's Conceptual Spaces at Work the first session listed includes this reference:

Adams, B., Raubal, M. (2009). Conceptual Space Markup Language (CSML): Towards the Cognitive Semantic Web. ICSC '09 Proceedings of the 2009 IEEE International Conference on Semantic Computing IEEE Computer Society Washington, DC, USA.

Abstract—CSML is a semantic markup language created for the publishing and sharing of conceptual spaces, which are geometric structures that represent semantics at the conceptual level. CSML can be used to describe semantics that are not captured well by the ontology languages commonly used in the Semantic Web. Measurement of the semantic similarity of concepts as well as the combination of concepts without shared properties are common human cognitive tasks. However, these operations present sources of difficulty for tools reliant upon set-theoretic and syllogistic reasoning on symbolic ontologies. In contrast, these operations can be modeled naturally using conceptual spaces. This paper describes the design decisions behind CSML, introduces the key component elements of a CSML document, and presents examples of its usage.

This is an excellent source. CSML is a really significant development for me as Adams and Raubal highlight on the first page:

The computational foundation of the Semantic Web is the formal representation of concepts and their relationships using the Resource Description Framework (RDF) and the Web Ontology Language (OWL) variants [5], [6]. These families of languages allow one to describe semantic relationships between concepts and ontologies, which can be queried using a first-order logic reasoner. An underlying assumption to these methods is the realist approach to semantics, which states that the meanings of concepts are in the real world. That is, there is a direct mapping between language terms and the world but there is no consideration of how individuals understand concepts differently. In contrast, cognitive semantics states that the meanings of terms are cognitive structures in people’s minds. This approach is of central importance for the Semantic Web, because web services interface with human users.

This isn't excellent or significant in the sense that the emergence of CSML demonstrates h2cm as a conceptual space.

Far from it.

Here and for h2cm CSML is obviously an essential tool to examine, understand and possibly extend. Anyone for PHP and XML (Drupal)? Reading the paper, it's clear that even thinking of applying CSML to Hodges' model demands answers to difficult and yet fascinating questions that involve nursing (theory, practice and values), informatics, philosophy and some maths too.

Image source:
http://www.lucs.lu.se/wp-content/uploads/2012/01/conceptual_spaces_wordl.png